Stage IV ESCC: CCRT tops chemotherapy for ORR, PFS, OS

  • Lyu J & al.
  • Radiat Oncol
  • 26 Nov 2018

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Treatment with concurrent chemoradiotherapy (CCRT) led to a better objective response rate (ORR), PFS, and OS than chemotherapy alone in patients with stage IV esophageal squamous cell carcinoma (ESCC).

Why this matters

  • Current NCCN guidelines recommend chemotherapy and/or palliative therapy alone in this population.
  • CCRT is standard of care for inoperable, locally advanced esophageal cancer, but its benefits and toxicity in other groups is not well known.

Study design

  • Retrospective analysis of 141 (55 CCRT; 86 chemotherapy only) patients at a single center who were treated from January 2010 and October 2015.
  • Funding: Wu Jieping Medical Foundation.

Key results

  • ORR: 74.5% CCRT vs 45.3% chemotherapy (P=.001).
  • Disease control rate: 94.5% CCRT vs 80.2% chemotherapy (P=.024).
  • CCRT improved OS vs chemotherapy alone (P= .007) at 1 year (58.0 vs 43.0%), 2 years (25.5 vs 14.0%), and 3 years (10.7 vs 4.7%).
  • CCRT yielded improved 1-year and median PFS (29.8 vs 14.9%; 8 vs 6 months; P= .005). 
  • Multivariable Cox model showed CCRT as a predictor of longer OS (HR, 0.631; P=.013).
  • CCRT was associated with a higher rate of grade ≥3 leukocytopenia (41.8% vs 24.4%; P=.040).

Limitations

  • Chinese population.
  • Monocentric, retrospective design.
  • Single institution.

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